At first glance, there may seem to be little difference between registered nurses, or RNs, and licensed practical nurses, or LPNs. Both administer medications, change dressings or insert catheters. Either may work in a hospital, clinic or doctors’ office. However, there are significant differences related to critical thinking skills, care planning, nursing scope of practice, education and overall responsibilities. RNs are independent in many areas, while LPNs -- also known as licensed vocational nurses -- must work under the supervision of an RN or physician and cannot practice independently.

Scope of Practice

Scope of practice defines the specific tasks a nurse is allowed to perform in a given state. Each state has a board of nursing; some states combine RNs and LPNs in the same board, while others have two separate boards. The board determines which tasks fall under the RN license and which can be performed by an LPN. The RN scope generally includes more complex and potentially dangerous tasks, such as titrating or adjusting a dose of medication based on a patient’s condition; invasive procedures, such as inserting a central venous catheter; or giving intravenous chemotherapy.

Nursing Process

The nursing process consists of four steps: assessment, planning, implementation and evaluation. The LPN has a limited role in each of those steps but cannot perform any of them completely or independently. The RN generally performs the initial physical assessment of a newly admitted patient and may also perform a daily assessment. An LPN might take the patient’s blood pressure and pulse, but she would report her findings to the RN, who would determine how those readings fit into the clinical picture for the individual patient and whether any changes should be made to the plan of care.

The Care Plan

Implementation of the care plan includes performing the daily care of the patient. For example, the RN would determine that the patient will benefit from walking at least three times a day and include that as an intervention on the care plan, while the LPN would actually help the patient walk. At the end of each shift, the RN evaluates the patient’s progress toward specific goals that will promote recovery and adjusts the plan as necessary, depending on the patient’s progress.

Critical Thinking

Only RNs can develop the care plan and make changes, although LPNs can contribute suggestions. Care planning and evaluation require critical thinking skills, including the ability to analyze information, consider underlying medical conditions and integrate that information into the overall picture of the patient’s health status. All of these skills are taught in nursing school but are not included in the LPN curriculum, which is focused on bedside tasks. The RN must always see the big picture for each patient.

About the Author

Beth Greenwood is a registered nurse and writer. She served as a columnist for the Tides Foundation's Community Clinic Voice on quality improvement and now contributes to various websites. Greenwood holds an Associate of Science in nursing from Shasta College and is a graduate of the California HealthCare Foundation Health Care Leadership Program.

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